Prevalencia de factores de riesgo para enfermedades crónicas no transmisibles en alumnos de medicina y sociología, Universidad de Valparaíso, 2009 / Risk factors prevalence for chronic non-transmissible diseases in medical and sociology students, Universidad de Valparaíso, 2009

INTRODUCCIÓN: Las enfermedades crónicas no transmisibles corresponden a una de las principales causas de morbimortalidad en Chile y el mundo. Si bien su etiología es multifactorial, los factores de riesgo para estas enfermedades son susceptibles de ser modificados. Estos actúan por larga data previa a la manifestación de una enfermedad crónica no transmisible, por lo que resulta interesante conocer la prevalencia de estos factores en la población universitaria de distintas áreas de conocimiento, quienes experimentan un cambio en el ritmo de vida que podría afectar sus hábitos. OBJETIVO: Estimar y comparar la prevalencia de factores de riesgo para enfermedades crónicas no transmisibles en estudiantes de Medicina y Sociología de la Universidad de Valparaíso, en general y estratificado por sexo. MATERIAL Y MÉTODO: Estudio de corte transversal realizado entre julio y octubre de 2009. Se seleccionaron 67 alumnos de cada carrera mediante muestreo estratificado y se aplicó encuesta considerando sexo, edad y hábitos, más la medición de peso, talla, circunferencia de cintura, presión arterial y glicemia capilar. Análisis realizado con STATA 10.0, usando pruebas de χ2 y t de Student, considerando p<0,05 e intervalos de confianza de 95 por ciento. RESULTADOS: Se encontró mayor prevalencia de consumo nocivo de alcohol (40,3 por ciento), tabaquismo (44,78 por ciento) y mala alimentación (64,18 por ciento) en Sociología(p=0,004, p<0,0001 y p=0,011, respectivamente); mientras que en Medicina se encontró mayor prevalencia de sedentarismo (73,13 por ciento, p=0,045), existiendo ciertas diferencias por sexo entre ambas carreras. DISCUSIÓN: Los alumnos de Sociología y Medicina presentan diferente prevalencia de factores de riesgo para enfermedades crónicas no transmisibles. Se recomienda realizar promoción de estilos de vida saludable en ambos grupos.

INTRODUCTION: Non-transmissible chronic diseases are a main cause of morbimortality in Chile and worldwide. Although its etiology is multifactorial, risk factors for these diseases are likely to be modified. These ones act by long terms of time before the appearance of a non-transmissible chronic disease, so it is interesting to know the prevalence of these factors among students of different areas of knowledge, who changes their lifestyle that could affect their habits. OBJECTIVE: Estimate and compare the prevalence of risk factors for non-transmissible chronic diseases on Universidad de Valparaíso’s Medicine and Sociology students, overall and stratified by sex. MATERIAL AND METHOD: A cross sectional study was carried out between July and October 2009. A number of 67 students of each career were chosen by stratified sampling. A questionnaire was applied considering sex, age and habits, also anthropometric measures, arterial pressure and capillary blood glucose, were determined. Analysis with STATA 10.0, using χ2 and Student’s t-test, considering p<0.05 and 95 percent confidence interval. RESULTS: We found higher prevalence of harmful consumption of alcohol (40.3 percent),smoking habit (44.78 percent) and bad nutrition (64.18 percent) in Sociology(p=0.004, p<0.0001 y p=0.011, respectively); whereas in Medicine was found a higher prevalence of sedentary lifestyle (73.13 percent, p =0.045), with some differences by sex between both careers. DISCUSSION: Sociology and Medicine students have different prevalence of risk factors for non-transmissible chronic disease. We recommend promoting healthy lifestyles in both groups.

Incorporación de contenidos de ciencias sociales y humanas en el currículum de medicina de la Universidad de Valparaíso / Adding human and social sciences in the medical curriculum in the University of Valparaíso

En el ano 2005 la Escuela de Medicina de la Universidad de Valparaíso inicio un proceso de innovación curricular con el propósito de entregar una formación mas humanista, de mejor calidad, desarrollando competencias en los futuros médicos que le permitan adaptarse a los nuevos escenarios del ejercicio profesional. Para dar a conocer el desarrollo de dicho proceso en la enseñanza de contenidos de Ciencias humanas y sociales, el presente trabajo realiza un análisis comparativo, mediante la revisión de todos los programas de las asignaturas y nuevos bloques curriculares impartidos entre el primer y quinto ano de la carrera, en los anos 2001 y 2007. Se identificaron los contenidos relacionados con ciencias sociales y humanas, y su carga horaria. De las 45 asignaturas del 2001, 11 presentaban los contenidos buscados (24,4 por ciento de cursos; 3,2 por ciento de horas totales). De los 33 programas impartidos el ano 2007, 12 tenían dichos contenidos (36,4 por ciento de cursos; 9,9 por ciento de horas totales). El peso curricular de los cursos con contenidos de ciencias humanas y sociales fue mayor en las asignaturas preclínicas (4,6 por ciento de horas en 2001 y 14,1 por ciento en 2007). En 2001 no se encontraron contenidos de investigación cualitativa, mientras que en 2007 si existen. La significación estadística de las diferencias encontradas es altísima (p<0,001). Se concluye que el proceso de innovación curricular genero un gran cambio sobre la cantidad de contenidos de ciencias humanas y sociales en el curriculum de medicina, lo que permitiría a los futuros/as médicos/as alcanzar una visión de la determinación social del proceso salud – enfermedad y de la practica de salud como fenómeno social. Se contribuiría así con el logro del propósito de una formación mas humanista que deje a los futuros profesionales con mejores competencias para la adaptación a las nuevas condiciones del ejercicio profesional.

In 2005, the School of Medicine of Valparaiso started a curricular innovation process. The purpose of this reform is to give a more humanistic and better quality education to develop competences for the future physicians, enabling them to adapt to new contexts of professional labor. In order to inform about the changes made in the contents of human and social sciences, and the time devoted to them, we reviewed the programs of all the subjects and curricular modules of the first to fifth years in 2001 and 2007. In 2001, 45 courses were evaluated, and eleven of them included the contents we were looking for: 24, 4 percent of courses and 3,2 percent of their total time. In 2007, 33 courses were evaluated, and in twelve of them we found the kind of contents referred to: 36,4 percent of the courses and 9,9 percent of their time). The proportion of courses with human and social sciences is higher in the first three years of the undergraduate program: 4,6 percent of scheduled hours in 2001 and 14,1 percent in 2007. Qualitative research methods were not taught in 2001; they were included in the course on Scientific Methodology in 2007. Statistical analysis shows that the differences in the percent of hours dedicated to the target contents, from 1st to 5th year and from the 1st to the 3rd, are highly significant. We conclude that the curricular innovation process had a great impact in including human and social sciences in medical education, thus providing better competencies for adaptating to the new contexts of professional work.

The effectiveness of a professionally led support group for men with prostate cancer.

PURPOSE: This study investigated the effectiveness of support groups in: (a) helping patients and significant others voice their concerns about the physical and psychosocial implications of their disease in an emotionally supportive context, (b) enhancing patients' understanding of their disease and its treatments and side effects, and (c) facilitating more active involvement in their treatment. A total of 54 men and some family members participated in seven separate groups. Patients were invited to participate with a letter describing the goals of the support groups or were referred by nurses and doctors. METHOD: The participants met for a series of 10 weekly sessions each of 90 minutes duration. The meetings were led by a nurse and a psychologist, who together provided information on the medical aspects of the disease and its treatment, focused on the psychologic reactions to a diagnosis of cancer, and encouraged participants to adopt more active, health-promoting coping strategies. RESULTS: The participants were surveyed anonymously by questionnaire at the end of the tenth session on their views and attitudes about the support groups and their overall satisfaction. The results showed that participants in the support group felt they had a better understanding of their illness and perceived themselves as more involved in their treatment. They expressed that sharing their experiences with others gave them reassurance, helped alleviate their anxiety, and provided them with a more positive outlook. CONCLUSION: It was concluded that these findings furnished evidence of the effectiveness of support groups in facilitating perceptions of enhanced coping in men with prostate cancer.

The international prostate symptom score: physician versus self-administration in the quantification of symptomatology.

OBJECTIVES: The International Prostate Symptom Score (IPSS), originally known as the American Urological Association Score, is the most commonly used scoring system for the quantification of benign prostatic hyperplasia symptoms. One area that has remained unexplored is the stability of the questionnaire construct between different modes of administration. The objective of this study was to measure differences in IPSS when administered by the physician versus patient self-administration. The impact of order of administration was also examined. METHODS: Sixty-four patients completed two IPSS questionnaires during the same office visit, one self-administered and the other by physician interview. The influence of order of administration was examined by randomly allocating patients to either self-administration or physician-administration first. Total symptom scores (questions 1 to 7) and quality of life scores (question 8) were compared between the two modes of administration. Multivariate analysis of variance was performed to assess the effect of age, medical history (obtained from the IPSS form), order of administration, and physician (A and B) on the observed differences. RESULTS: The distribution of differences was similar between the two orders of administration. Overall, 26 patients had a higher total score with self-administration, 30 with physician-administration, and 8 had identical scores on both. Mean total symptom scores and quality of life assessments by physician- versus patient-administered questionnaires were similar (10.9 versus 10.4 and 1.8 versus 2.2, respectively). No statistically significant difference was observed. The order of administration did not show statistical significance (P > 0.05) by multivariate analysis. As well, no interaction was seen between the aforementioned variables. CONCLUSIONS: There is no difference in the information obtained if patients self-administer the questionnaire as opposed to physician administration.

Atrial natriuretic factor in pregnancy and pregnancy-induced hypertension.

In normal pregnancy, cross-sectional clinical data do not consistently show plasma ANF concentration differences between early pregnancy and the nonpregnant state. Sequential data in the baboon (but not in rat) show a significant decrease in plasma ANF concentration and in cardiac filling pressures in early pregnancy. The latter data support the view that pregnancy is an underfill state secondary to a primary vasodilatation. Cross-sectional and longitudinal studies in normal pregnancy in humans show that plasma ANF levels tend rise to values that are, in the third trimester, higher than in the nonpregnant state. However, late postpartum sequential data (1.5-3 months) in humans do now show a significant drop in plasma ANF concentrations, suggesting that plasma ANF is not actually increased in normal pregnancy. In the baboon (but not in the rat) there is a steady rise in plasma ANF levels to values that are significantly higher in third trimester than before pregnancy. These data suggest that in human pregnancy, in contrast with the baboon, the plasma volume expansion induced by normal pregnancy is not sensed as such by the atria probably because of an isopressive adaptation of plasma volume to an enlarged vascular bed. However, acute decrease or increase of venous return induced by low sodium diet, changing position or infusion of isotonic saline are sensed as such by the atria in normal pregnancy as in the nonpregnant state.(ABSTRACT TRUNCATED AT 250 WORDS)

[Increase of the pressor response to angiotensin II in normal pregnancy. A sign of increasing blood volume more than decreasing vascular reactivity]. / L'augmentation de la dose pressive d'angiotensine II au cours de la grossesse normale. Un reflet de l'augmentation de la volémie plutôt que la diminution de la réactivité vasculaire.

Plasma volume and the pressor dose of angiotensin II were estimated in 15 normotensive pregnant women during the second and third trimester and 2-3 months post-partum together. Plasma volume estimated by the Evans Blue technique increased during pregnancy significantly more than the body weight: its increase was 37 and 54% of the post-partum values whereas the body weight increase was only 6 and 12%. The pressor dose of angiotensin II was significantly increased during pregnancy only when it was related to body weight (14.2 +/- 4.3 and 14.9 +/- 5.2 at the 2nd and 3rd trimester versus 11.2 +/- 2.9 ng min-1 kg-1 BW post-partum) but not when it was related to plasma volume (0.25 +/- 07 and 0.26 +/- 0.09 versus 0.25 +/- 0.07 ng min-1 ml-1 PV). It is concluded that the increased pressor dose of angiotensin II (related to body weight) observed in normal pregnancy cannot be interpreted as an evidence for decreased vascular reactivity but that it could be a mere reflection of plasma volume increase.

Reduction in testicular function in rats. I. Reduction by a specific gonadotropin-releasing hormone antagonist in fetal rats.

A gonadotropin-releasing hormone (GnRH) antagonist, when injected 24 h before sacrifice to rat fetuses, did not modify plasma testosterone concentrations in males on day 18 of gestation but it did on days 19, 20 and 21. This GnRH antagonist reduced plasma luteinizing hormone (LH) levels and increased pituitary LH content in both male and female 19-day-old fetuses from mothers adrenalectomized on day 14 of gestation. An inverse relationship between plasma testosterone and LH levels was noted in males and females, on days 19 and 21. These data suggest that the hypothalamic control of gonadotropic function is operating by day 19 of fetal life and that a negative feedback of testosterone on LH and probably GnRH release is also operating in rat fetuses on days 19 and 21 of gestation.

Reduction in testicular function in rats. II. Reduction by dexamethasone in fetal and neonatal rats.

Chronic administration of dexamethasone in drinking water to maternal rats from days 15 to 21 of gestation (1) reduced plasma testosterone concentrations in male fetuses between days 19 and 21 but not earlier on day 18 and abolished the prenatal peak of plasma testosterone which normally occurs on day 19 of gestation, and (2) suppressed the postnatal surge of plasma testosterone in male newborns 1.5 and 2 h after delivery at term by cesarean section. The administration of dexamethasone to male fetuses at birth induced 1 h later a slight but not significant increase in hypothalamic gonadotropin-releasing hormone (GnRH) and pituitary luteinizing hormone (LH) contents, reduced drastically plasma LH levels and completely prevented the postnatal surge of plasma testosterone which occurred normally in littermate controls. A rise in pituitary LH content, and a sharp reduction in plasma LH and testosterone concentrations were noted in 19-day-old male fetuses whose mothers were acutely treated with dexamethasone on day 18 of gestation. Similar evolutions for LH were observed in littermate females. These results suggest that the inhibitory effects of exogenous glucocorticoids on testosterone secretion could be mediated in both fetuses and newborns at least partially through suppression of the hypothalamic and pituitary secretion of GnRH and LH, respectively, and provide insight how stress or hormone imbalance may affect the development of this neuroendocrine system.

Plasma atrial natriuretic factor and urinary excretion of a ouabain displacing factor and dopamine in normotensive pregnant women before and after delivery.

Estimation of urinary excretion of a ouabain displacing factor and dopamine was carried out immediately before delivery, and 7 days and 70 to 90 days after delivery in 12 normotensive pregnant women. Simultaneous estimation of plasma 99-126 atrial natriuretic factor, plasma renin activity, and plasma aldosterone were also undertaken. The data were compared with those obtained in a group of nonpregnant normotensive women (n = 14) and a group of pregnant normotensive women in the early phase of the third trimester (n = 14). Urinary ouabain displacing factor and dopamine levels were significantly higher in the early phase of the third trimester, as compared with nonpregnant women. But immediately before delivery, ouabain displacing factor excretion had fallen below nonpregnant values and dopamine excretion had dropped to control values. Both remained low after delivery. Plasma atrial natriuretic factor was higher in pregnant women, as compared with nonpregnant controls and remained high just before delivery and 7 and 70 to 90 days after delivery. Plasma renin activity and plasma aldosterone levels were higher during pregnancy and had fallen to nonpregnant values 7 days post partum. This drop in plasma renin activity and aldosterone by 7 days post partum, in contrast with the unchanged high values of atrial natriuretic factor, may contribute to negative sodium balance after delivery. It is concluded that there is considerable discrepancy in natriuretic and antinatriuretic factors before and after delivery.

[Sequential study of the plasmatic atrial natriuretic factor and the urinary excretion of an ouabain displacing factor and of dopamine in normotensive pregnant women before and after labor]. / Etude séquentielle du facteur atrial natriurétique plasmatique et de l'excrétion urinaire d'un facteur déplaçant l'ouabaïne et de la dopamine chez la femme enceinte normotendue avant et après l'accouchement.

Estimation of urinary excretion of a ouabain displacing factor (ODF) and dopamine was carried out immediately before delivery, 7 days and 70-90 days after delivery in 12 normotensive pregnant women. Simultaneous estimation of plasma 99-126 atrial natriuretic factor (ANF), plasma renin activity (PRA) and plasma aldosterone were also undertaken. The data were compared with those obtained in a non pregnant normotensive group of women (n = 14) and a group of pregnant normotensive women in the early third trimester (n = 14). Urinary ODF and dopamine were significantly higher in the early third trimester when compared with non pregnant women but immediately before delivery, ODF excretion had fallen below non pregnant values and dopamine excretion had dropped to control values. Both remained low after delivery. Plasma ANF was higher in pregnant women when compared with non pregnant controls and remained high just before delivery and 7 and 70-90 days after delivery. PRA and plasma aldosterone were higher during pregnancy and had fallen to non pregnant values 7 days post-partum. It is concluded that there is considerable discrepancy in the evolution of natriuretic and antinatriuretic factors before and after delivery and that the drop of PRA and aldosterone by 7 days post-partum, contrasting with the unchanged high values of ANF, may contribute to negative sodium balance after delivery.

A ouabain-displacing factor in normal pregnancy, pregnancy-induced hypertension and pre-eclampsia.

1. A ouabain-displacing factor (ODF) was measured in the urine of non-pregnant, normotensive pregnant and hypertensive pregnant women by a receptor-binding assay with sodium, potassium-dependent adenosine triphosphatase. 2. Urinary ODF was significantly increased in normal pregnancy. 3. Greater increases were seen in pregnancy-induced hypertension and pre-eclampsia.

Atrial natriuretic factor in pregnancy-induced hypertension and preeclampsia: increased plasma concentrations possibly explaining these hypovolemic states with paradoxical hyporeninism.

Plasma immunoreactive atrial natriuretic factor 99-126 (ir ANF), plasma volume, plasma renin activity, and plasma aldosterone were measured during pregnancy in 14 normotensive nonpregnant women, 15 normotensive pregnant women, 35 patients with pregnancy-induced hypertension (PIH), and in ten patients with preeclampsia (PE). Repeated measurements were carried out 2 months after delivery in a subgroup of the same patients. The plasma levels of ANF were found to be higher in pregnant normotensive women than in nonpregnant normotensive women, but the decrease of plasma ANF 2 months after delivery was not significant on the basis of seven paired data, so that it cannot presently be stated with certainty that pregnancy per se stimulates ANF secretion. Still higher levels of ANF were found in PIH and, especially, in PE. A positive correlation was found in the pooled population of normotensive and hypertensive pregnant women between plasma ANF and mean arterial pressure. A greater decrease of plasma ANF was found after delivery in the hypertensive patients than in the normotensive controls. This excludes an absolute deficiency of ANF secretion in the pathogenesis of hypertension. These findings suggest a compensatory role of ANF in the prevention of blood pressure increase. Plasma renin activity (PRA) and plasma aldosterone concentrations were higher in normotensive pregnant women than in normotensive nonpregnant women. Compared to normal pregnancy, plasma volume was decreased in PIH (-17%) and in PE (-25%), whereas PRA was less increased in both groups and plasma aldosterone concentration was less increased only in the PE group. The simultaneous high levels of plasma ANF may explain this inappropriate hypostimulation of renin secretion by hypovolemia in these hypertensive states.

Prostanoid synthesis by isolated rat glomeruli: effect of oestrous cycle and pregnancy.

1. An increase in glomerular prostaglandin (PG) synthesis has been reported in two experimental models of increased glomerular filtration rate (GFR). 2. Because pregnancy, in women and rats, is also associated with an increased GFR, we studied PG biosynthesis by glomeruli isolated from pregnant rats in comparison with virgin rats at the different phases of the oestrous cycle. 3. PGE2 and PGF2 alpha synthesis markedly increased during pregnancy (at day 21 of gestation a five- to sevenfold increase of PGE2 and PGF2 alpha was seen; at day 15 of gestation a threefold increase of PGE2 and a sixfold increase of PGF2 alpha was noted). However, thromboxane A2 (TXA2) synthesis was similar in all the groups studied. 4. Among the four phases of the oestrous cycle, dioestrus was characterized by a significant increase in glomerular synthesis of PGE2. 5. The fact that during pregnancy the increase in the vasodilator PGE2 is not counteracted by an increase in the constrictor TXA2 must be taken into account when explaining the glomerular hyperfiltration which characterizes the pregnant state. 6. The increase of PGE2 synthesis during dioestrus should be considered in studies of PG synthesis using virgin rats as controls.

[Pregnancy-induced hypertension and pre-eclampsia develop in spite of high circulating levels of cardionatrin]. / L'hypertension induite par la grossesse et la prééclampsie se développent malgré des taux circulants élevés de cardionatrine.

Plasma cardionatrine was measured during pregnancy in 14 normotensive non pregnant women, 15 normotensive pregnant women, 35 pregnancy induced hypertension (PIH) and 10 preeclampsia (PE) and again 2 months after delivery in respectively 7, 15 and 7 cases together with plasma volume, PRA and plasma aldosterone. The plasma levels of cardionatrine are higher in pregnant normotensive women than in non pregnant normotensive women suggesting that pregnancy per se stimulates cardionatrine secretion. The higher levels of cardionatrine in PIH and specially in PE during pregnancy and the greater decrease of plasma cardionatrine after delivery in the hypertensive patients than in the normotensive controls exclude a deficiency of cardionatrine secretion in the pathogenesis of hypertension. These data rather suggest a compensatory role of cardionatrine in the prevention of blood pressure increase. Plasma volume was decreased in PIH (-17 p. 100) and in preeclampsia (-25 p. 100). The simultaneous high levels of cardionatrin may explain the inappropriate stimulation of the renin and aldosterone secretion in these hypovolemic hypertensive states.

[Digoxin-like natriuretic factor, raised during normal pregnancy, is increased in pregnancy-induced hypertension and pre-eclampsia]. / Le facteur natriurétique digoxin-like, augmenté dans la grossesse normale, est majoré dans l'hypertension induite par la grossesse et la prééclampsie.

UNLABELLED: The increase of peripheral resistance in pregnancy induced hypertension (PIH) and in preeclampsia (PE) is not yet explained since previous studies have found that renin-angiotensin-aldosterone system is actually depressed, that adrenergic system is inconstantly stimulated and that vasodilating prostaglandins are inconstantly decreased. In order to get a better insight in the pathogenesis of PIH and PE, we have measured the 24 h urinary excretion of digoxin-like natriuretic factor (DLF) in 15 normotensive pregnant women (NP), in 29 women with PIH and in 6 women with PE under normal salt diet, without treatment. DLF have been measured by radio receptor binding assay. Normal values were established in 14 normotensive non pregnant (NNP). In NP, 24 h urinary excretion of DLF was significantly higher than in NNP (respectively 14.9 +/- 7.5 and 9.5 +/- 2.5 nmol/mmol of creatininuria, p less than 0.01). Comparatively to NP, 24 h urinary excretion of DLF was significantly higher in PIH (31.7 +/- 19 nmol/mmol of creatininuria) and in PE (40.7 +/- 16.3 nmol/mmol of creatininuria). In PIH and PE, there were simultaneously a decrease of plasma renin activity and plasma volume but no difference for plasma catecholamines. IN CONCLUSION: 1. the production of DLF is increased by normal pregnancy; 2. it is increased in PIH and PE in comparison with NP and may explain the increase of peripheral resistance.

[Perinatal influence of sex hormones on the differential activation of corticotrope function during stress in the male and female]. / Influence périnatale des hormones sexuelles sur l'activation différentielle de la fonction corticotrope au cours d'un stress chez le mâle et la femelle.

The stress-induced activation of the corticostimulating function of the pituitary gland was noted to vary according to sex in both the adult and the newborn. The pituitary response in testosterone or estradiol-injected females at the time of birth was similar to that of intact males, in contrast, the castration of the males performed just before the postnatal surge of plasma testosterone was unable to modify at the 8th day, the male characteristic evolution in response to ether inhalation. Present data suggest--in the male, prenatal differentiation of the neuroendocrine pathways involved in the pattern of ACTH release in response to ether inhalation, probably in correlation with the peak of plasma testosterone on day 19 of gestation--in the female, the existence of androgen--sensitive structures in early postnatal life. An alpha stimulatory effect of norepinephrine on these neuroendocrine pathways was suggested. Present report also discuss--the catecholaminergic control of CRF X producing neurons--the sex dependent AVP and/or oxytocin (OT) release induced by a stress--the AVP and OT potentiation of CRF-induced ACTH release.

[Evaluation of maximal filtration capacity and renal functional reserve by an oral protein-loading test in adults and children]. / Evaluation de la capacité maximale de filtration et de la réserve fonctionnelle rénale par un test de charge orale en protides chez l'adulte et chez l'enfant.

After a protein load, the glomerular filtration increases to a maximum called maximal filtration capacity (MFC). The difference of this value with that observed in the fasting state defines the functional renal reserve (FRR). Fifty oral protein loads have been performed in 16 controls (13 adults and 3 children) and 31 patients with kidney disease or hypertension (22 adults, 9 children, 3 tests being performed twice). The load consisted in the adults of 80 g of various proteins. In the children the load consisted in the 100% of the protein intake recommended of the whole day. The urinary samples were made hourly during the 5 hours following the beginning of the meal. The MFC was not always observed during the 2 hours following the end of the meal. However the mean of the clearances measured during these 2 hours allowed an acceptable evaluation of the FRR in 42 out of 50 cases and had the advantage to reduce the errors linked to incomplete bladder voiding. In the adult controls the mean of hourly determined MFC is 156 +/- 27 ml/min, the mean of the clearances measured on the 2 hours following the meal is 136 +/- 21 ml/min and the fasting clearance 96 +/- 22 ml/min. The FRR is null in all patients with a nephropathy with a fasting clearance below 40 ml/min. It is modest or null in patients with acquired or congenital solitary kidney. Three out of five patients with proteinuria have MFC and FRR higher than the mean of the patients with comparable fasting clearances but without proteinuria suggesting that proteinuria is associated with a hyperfiltration state.